A Pediatricians' Raw Experience in Private Independent Medical Practice on the front lines.

Monday, May 9, 2016

Tried and True Advice for Picky Eaters

One of the most common questions a pediatrician can
be asked is about picky eaters.I have
given my “picky eater” talk at least once every day for the last two weeks, so
I decided to make this the next topic to cover.Interestingly enough, this talk is the same for skinny kids as well as
those who are overweight or obese (though I am not fond of that word.)

To clarify, the following is my opinion based on my
experience and is not evidence-based or scientifically proven.It has helped many children who are
overweight stabilize and “grow” into their proper weight and it helps
underweight children eat more variety and volume.It is safe and I have not had any children
starve while on this plan.Obviously, if
you are going to take my advice then please use good old-fashioned common sense
when applying the principles below.

First and most important, the child needs to
actually be hungry.In all honesty, they
need three solid meals per day.They do
not need a constant barrage of crackers in Ziploc bags, dried fruit, yogurt
tubes, and those squeezable packages while on the go.Snacking frequently causes cavities and
prevents children from experiencing actual hunger, setting them up for weight
difficulties in the future.I tell
parents if there is a long period of time between lunch and dinner than a small
snack is acceptable but it should follow the rules below.

Second, it needs to be an event. This means turn off the TV or computer, hang up
the phone, put down the electronic device and sit down at the table. Preferably
have the entire family sitting at the table whenever possible.Food
should only be eaten sitting down, not while walking around at the park.Eating is such an enjoyable experience that
we should teach little ones early to focus and enjoy it, even if a meal is
three bites for them.

Third, children model the behavior they see, so we
should be eating a wide variety of foods from all the food groups. Personally, I am a fan of families eating red
meat because the most common nutritional deficiency in the United States in
children is iron-deficiency, which can lead to learning problems later in
school.If you can get other iron
containing foods into your child instead of meat, then go for it.Bottom line, variety and modeling are the
take-home points.

Fourth, do not let your picky eater drink their
food.Our house rule is half the meal
has to be eaten before the milk is poured.I had to learn this one watching mine down a glass of milk and say they
were full a few times before I got with the program.We only serve water at the start of meals to
make sure they do get some variety and not just the OJ in the morning and milk for
the other meals of the day.

Fifth, if they plain do not like it and will not eat
it you have two options.Either they
miss that meal and eat the next one or come up with what I call the “back-up
food option.”I developed this after my
oldest refused dinner for three nights in a row.You might not believe anything else I write
after you read this next sentence, so prepare yourself, a confession is
coming.Our family “back-up” is a 100%
beef, no nitrate hot dog.At least you
know I am completely honest right?

My oldest ate this every night for more than nine
months until one day he finally ate the spaghetti we made for the family dinner
and the rest is history.I tell most
families to pick one neutral “back-up option” and all the children will know
they either eat what you have served or they get the same thing all the time as
the alternative.Do not change the “back-up
food” over time because the end goal is not to encourage them to choose it
repeatedly.Instead you would like them
to get tired of it and eat something else.It will happen, believe me.

Sixth, understand that some children love pureed
foods and want to eat them until they are three.Some children dislike pureed foods from the
get go and love smashed avocado, banana and steamed vegetables they can hold in
their tiny hands.Every child has
diverse taste preference and chewing abilities at different ages.That is absolutely acceptable and completely normal
developmentally.

Finally, we should talk about snacks.A snack should consist of something natural
of which they are not particularly fond (i.e. not crackers, which is the #1
favorite food of most picky eaters.)My
favorite recommendations are celery and peanut butter, carrot sticks and string
cheese, or apple and yogurt.It should
always include something with protein.Remember, it is still an event and they should not be able to walk
around while eating it.Also, there
should be at least two hours between eating a snack and then serving a meal to
allow them to become hungry again.

In closing, I would like to say there will be times
when they are growing rapidly and times they are not.Remember, puberty is just around the corner and
food will disappear right before your eyes.Sometimes a meal will be everything you put on their plate or truly just
three bites.A child’s appetite changes
daily as do their nutritional needs.They are much better at eating when hungry
and stopping when full than we are as adults.Let them experience what it feels like to be hungry, enjoy their food,
and then feel full.It is one of the
many important lessons we teach children.Allow them to learn it.